Silvia Costella

Exhaled air temperature in asthma: methods and relationship with markers of disease.

Background Exhaled breath temperature has been proposed as a surrogate marker for the evaluation of airway inflammation in asthmatic patients.

Mite avoidance can reduce air trapping and airway inflammation in allergic asthmatic children

Background We investigated the effects of prolonged allergen avoidance in 18 house dust mite‐sensitized asthmatic children during a prolonged residential period at a high altitude, allergen‐free environment.

Reduction in exhaled nitric oxide immediately after methacholine challenge in asthmatic children

Background: The measurement of exhaled nitric oxide (NO) has recently been proposed as a useful technique for the evaluation of airway inflammation in asthma. The purpose of this study was to determine the effect of methacholine bronchial provocation on the levels of exhaled NO in asthmatic children. Method: Exhaled NO was measurement immediately before and after methacholine provocation in 51 children with mild to moderate asthma. Results: A significant decrease occurred in the level of exhaled NO (p<0.0001) after methacholine bronchial provocation which was not correlated with the percentage fall in forced expiratory volume in 1 second (FEV1). Conclusions: The methacholine test should not be used immediately before measurement of exhaled NO in children with asthma.

Eosinophilic airway inflammation is increased in children with asthma and food allergies.

To cite this article: Kulkarni N, Ragazzo V, Costella S, Piacentini G, Boner A, O’Callaghan C, Fiocchi A, Kantar A. Eosinophilic airway inflammation is increased in children with asthma and food allergies. Pediatric Allergy Immunology 2012: 23: 28–33.

Exhaled nitric oxide is reduced after sputum induction in asthmatic children

Exhaled nitric oxide (ENO) and eosinophil sputum markers are considered noninvasive markers of airway inflammation in asthma. The aim of this study was to evaluate whether the procedure of sputum induction can affect the level of ENO. We measured ENO before and after sputum induction by inhalation of hypertonic saline solution in 22 asthmatic children and 9 healthy controls.

Effect of montelukast on exhaled NO in asthmatic children exposed to relevant allergens

The level of exhaled nitric oxide (FENO) is increased in house dust mite (HDM)‐sensitized asthmatic children after exposure to HDM antigen, and inhaled steroids can prevent this increase. The aim of this study was to evaluate whether montelukast could prevent an increase in FENO levels in allergic asthmatic children after a brief period of exposure to relevant allergens. Sixteen children were evaluated at the residential house ‘Istituto Pio XII’ (Misurina, Bellunio, Italy) in the Italian Alps, a dust mite‐free environment. FENO levels were evaluated before (t0) and immediately after (t1) the children were exposed to HDM allergens for 2 weeks in their homes at sea level. No significant difference in FENO was observed in the fluticasone‐treated group of children after 2 weeks at sea level. In the group treated with montelukast, an increase in FENO was observed between t0 and t1, which failed to reach statistical significance. These preliminary data suggest that oral montelukast could be effective in preventing the relapse in airway inflammation in allergic asthmatic children who are occasionally exposed to relevant allergens for a short period of time.

Exhaled NO reduced on allergen avoidance.

double the size of the injection bleb, and which shows signs of erythema surrounded by ̄are. The IDT is compared to a positive control (codeine phosphate: 50 mg/ml) and a negative control (saline solution). In our subjects, the rate of the mediators had increased. The prick tests to ICMs were 50% negative, whereas the IDTs were positive every time (Table 1). The severity of and time lapse in the onset of clinical signs, prior exposure, increase in tryptase level which seemed to be correlated to the severity of the reaction (3), positivity of IDTs, and reintroduction of a nonreactive ICM in cutaneous tests without incident all support the hypothesis of IgE mediation. Thus, cutaneous tests appear to be of prime importance in identifying the culprit ICM. ICMs are viscous and spread with dif®culty into the epidermis. This may explain the negativity of prick tests. On the other hand, IDTs seem to be more appropriate for a reaction that provokes every time a wheal at least double the injection wheal. However, this test is positive according to the degree of sensitivity of each patient: the more the patient is sensitized, the weaker the reactive concentration is. The test starts at 10 and goes to 10, a concentration that does not produce histamine release, even with hyperosmolar ICMs, as proved by negative IDTs at 10 for ioxitalamate (Telebrix) in nonallergic patients who presented an incident of mild severity to this ICM (1). Therefore, we suggest that patients who have had an anaphylactoid reaction to an ICM injection should have their tryptase level measured (considered as the marker of mast-cell activation) (5) and should undergo intradermal tests so as to identify and eliminate the culprit ICM in order to avoid any subsequent allergic accidents. Searching for cross-sensitization seems to be necessary. In two cases, this has enabled us to determine to which ICMs the patients were not sensitized and to inject them with these safely.